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America Can't Afford to Ignore Gout Any Longer

By Kenneth Thorpe
August 30, 2018
Almost 4 million Americans suffer from gout, a form of inflammatory arthritis that causes devastating pain.
For decades, this disease largely flew under doctors’ radar. Experts mistakenly believed that gout-related spending totaled just $6 billion annually — an insignificant 0.0018 percent of the nation’s $3.3 trillion health-care spending.
But a new study shows that gout is dramatically more expensive, since it compounds patients’ other chronic conditions. Total spending on gout patients reached $53 billion in 2015, according to research from my organization, the Partnership to Fight Chronic Disease.
America can’t afford to ignore gout any longer. Doctors could better help patients manage gout symptoms by prescribing a few dietary changes and medications. These simple treatments would improve patients’ quality of life and curb the nation’s health spending.
Gout patients suffer from a build-up of uric acid in the blood. When this uric acid crystallizes in people’s joints, they experience crippling pain that’s sometimes described as worse than childbirth. Often, the pain is so bad that patients can’t even move.
The cost of gout is equally debilitating. Gout patients spend more than $11,000 each year to manage their health problems. By contrast, people with no chronic illnesses spend less than $2,000 annually on health care, on average.
Nearly all gout patients suffer from at least one other chronic condition, such as hypertension or diabetes. Sixty-five percent of gout patients endure a staggering five or more chronic conditions. For instance, 30 percent of gout patients suffer from diabetes, compared to only 9 percent of all U.S. adults.
These diseases exacerbate each other. For example, gout is so painful that many patients cannot exercise regularly. As a result, they’re at higher risk for obesity.
Obese people’s bodies often can’t process all the uric acid they take in from food and sugar-sweetened drinks. That leads to uric acid build-ups — and thus gout attacks. It’s a vicious, self-perpetuating cycle.
Gout patients require frequent hospitalizations to manage their disease. In the past two decades, gout patients were hospitalized nearly 100 times more often than the general U.S. population, according to a study led by a Stanford University adjunct clinical professor of medicine. They spend over $900 million annually on ambulatory services alone as a result of their illness.
It would be simple to reduce the enormous societal and personal costs of gout. First, doctors should screen patients for risk factors, which include excessive uric acid, genetics, diet, medications, the existence of two or more chronic illnesses, and exposure to lead. Physicians could then advise at-risk patients to avoid foods like red meat, seafood, and beer that trigger the buildup of uric acid in the first place. Doing so would decrease the frequency at which patients experience gout episodes.
Doctors could also prescribe uric acid-reducing medications more liberally. These medications slash health-care costs, according to my research. The average patient spends $300 to treat a gout episode — but that figure declines by $135 if the patient is on uric acid-reducing drugs.
Uric acid-reducing medications also improve patients’ quality of life. On average, patients who received these drugs scored 5 percent higher on the SF-12, an index that measures their health-related quality of life. And they worked two more hours per week than patients who didn’t take the medication.
Gout is far more expensive than health experts once realized. Physicians can improve patients’ lives and save our health-care system billions of dollars by prescribing dietary changes and simple cost-effective medicines.
Kenneth E. Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease.